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					  Summary Protocol Form (SPF)
  University Human Research Ethics Committee
  Office of Research – Ethics and Compliance Unit: GM 1000 – 514.848.2424 ex. 2425

Approval of a Summary Protocol Form (SPF) must be issued by the applicable Human
Research Ethics Committee prior to beginning any research involving human participants.
The University Human Research Ethics Committee (UHREC) reviews all Faculty and Staff
research, as well as some student research (in cases where the research involves more than
minimal risk - please see below).
Research funds cannot be released until appropriate certification has been obtained.

For faculty and staff research
Please submit one signed copy of this form to the UHREC c/o the Research Ethics and
Compliance Unit, GM-1000. Please allow one month for the UHREC to complete the review.

Electronic signatures will be accepted via e-mail at

For graduate or undergraduate student research
  •   If your project is included in your supervising faculty member’s SPF, no new SPF is
  •   Departmental Research Ethics Committees are responsible for reviewing all student
      research, including graduate thesis research, where the risk is less than minimal. In
      Departments where an ethics committee has not been established, please contact the
      Research Ethics and Compliance Unit.
  •   In cases where the student research is more than minimal risk (i.e. the research involves
      participants under the age of 18yrs, participants with diminished capacity, participants from
      vulnerable populations or participants from First Nations), an SPF must be submitted to the
      UHREC, c/o the Research Ethics and Compliance Unit, GM-1000, by the Course
      Instructor/Supervisor on the student’s behalf.

This document is a form-fillable word document. Please open in Microsoft Word, and tab
through the sections, clicking on checkboxes and typing your responses. The form will expand
to fit your text. Handwritten forms will not be accepted. If you have technical difficulties with
this document, you may type your responses and submit them on another sheet. Incomplete or
omitted responses may cause delays in the processing of your protocol.

  Does your research involve

         Participants under the age of 18 years?
         Participant with diminished mental or physical capacity?
         Aboriginal peoples?
         Vulnerable groups (refugees, prisoners, victims of violence, etc. )?

1. Submission Information
Please provide the requested contact information in the table below:

  Please check ONE of the boxes below :

         This application is for a new protocol.

         This application is a modification or an update of an existing protocol:
         Previous protocol number (s):

2. Contact Information
Please provide the requested contact information in the table below:

  (must be Concordia
  faculty or                            Internal      Phone
  staff member)      Department         Address       Number           E-mail

  Co-Investigators / Collaborators      University / Department        E-mail

  Research Assistants                   Department / Program           E-mail

3. Project and Funding Sources

  Project Title:

In the table below, please list all existing internal and external sources of research funding, and
associated information, which will be used to support this project. Please include anticipated
start and finish dates for the project(s). Note that for awarded grants, the grant number is
REQUIRED. If a grant is an application only, list APPLIED instead.

  Funding                                                     Grant       Award Period
  Source           Project Title                              Number      Start      End

4. Brief Description of Research or Activity
Please provide a brief overall description of the project or research activity. Include a
description of the benefits which are likely to be derived from the project. Do not submit your
thesis proposal or grant application.

5. Scholarly Review / Merit
Has this research been funded by a peer-reviewed granting agency (e.g. CIHR, FQRSC,

         Yes         Agency:
                     If your research is beyond minimal risk, please complete and attach the
                     Scholarly Review Form

6. Research Participants
a) Please describe the group of people who will participate in this project.

b) Please describe in detail how participants will be recruited to participate. Please attach to
   this protocol draft versions of any recruitment advertising, letters, etcetera which will be

c) Please describe in detail how participants will be treated throughout the course of the
   research project. Include a summary of research procedures, and information regarding the
   training of researchers and assistants. Include sample interview questions, draft
   questionnaires, etcetera, as appropriate.

7. Informed Consent
a) Please describe how you will obtain informed consent from your participants. A copy of
   your written consent form or your oral consent script must be attached to this protocol.
   Please note: written consent forms must follow the format of the sample consent form
   template provided for you at the Ethics and Compliance webpage

b) In some cultural traditions, individualized consent as implied above may not be
   appropriate, or additional consent (e.g. group consent; consent from community leaders)
   may be required. If this is the case with your sample population, please describe the
   appropriate format of consent and how you will obtain it.

 8. Deception and Freedom to Discontinue
a) Please describe the nature of any deception, and provide a rationale regarding why it must
   be used in your protocol. Is deception absolutely necessary for your research design?
   Please note that deception includes, but is not limited to, the following: deliberate
   presentation of false information; suppression of material information; selection of
   information designed to mislead; selective disclosure of information.

b) How will participants be informed that they are free to discontinue at any time? Will the
   nature of the project place any limitations on this freedom (e.g. documentary film)?

9. Risks and Benefits
 a) Please identify any foreseeable risks or potential harms to participants. This includes
    low-level risk or any form of discomfort resulting from the research procedure. When
    appropriate, indicate arrangements that have been made to ascertain that subjects are in
    “healthy” enough condition to undergo the intended research procedures. Include any
    “withdrawal” criteria.

 b) Please indicate how the risks identified above will be minimized. Also, if a potential risk
    or harm should be realized, what action will be taken? Please attach any available list of
    referral resources, if applicable.

 c) Is there a likelihood of a particular sort of “heinous discovery” with your project (e.g.
    disclosure of child abuse; discovery of an unknown illness or condition; etcetera)? If so,
    how will such a discovery be handled?

10. Data Access and Storage
a) Please describe what access research participants will have to study results, and any
   debriefing information that will be provided to participants post-participation.

b) Please describe the path of your data from collection to storage to its eventual archiving or
   disposal. Include specific details on short and long-term storage (format and location), who
   will have access, and final destination (including archiving, or any other disposal or
   destruction methods).

  11. Confidentiality of Results
Please identify what access you, as a researcher, will have to your participant(s) identity(ies):

                                Researcher will not be able to identify who participated at
         Fully Anonymous        all. Demographic information collected will be
                                insufficient to identify individuals.
                                The participation of individuals will be tracked (e.g. to
         Anonymous results, but
                                provide course credit, chance for prize, etc) but it would
         identify           who
                                be impossible for collected data to be linked to
                                Data collected will be linked to an individual who will
                                only be identified by a fictitious name / code. The
                                researcher will not know the “real” identity of the
                                Researcher will know “real” identity of participant, but
                                this identity will not be disclosed.
                                Researcher will know and will reveal “real” identity of
                                participants in results / published material.
                                Participant will have the option of choosing which level
         Participant Choice
                                of disclosure they wish for their “real” identity.
         Other (please describe)

a) If your sample group is a particularly vulnerable population, in which the revelation of their
   identity could be particularly sensitive, please describe any special measures that you will
   take to respect the wishes of your participants regarding the disclosure of their identity.

b) In some research traditions (e.g. action research, research of a socio-political nature) there
can be concerns about giving participant groups a “voice”. This is especially the case with
groups that have been oppressed or whose views have been suppressed in their cultural
location. If these concerns are relevant for your participant group, please describe how you will
address them in your project.

12. Additional Comments
a) Bearing in mind the ethical guidelines of your academic and/or professional association,
   please comment on any other ethical concerns which may arise in the conduct of this
   protocol (e.g. responsibility to subjects beyond the purposes of this study).

b) If you have feedback about this form, please provide it here.

13. Signature and Declaration
Following approval from the UHREC, a protocol number will be assigned. This number must
be used when giving any follow-up information or when requesting modifications to this

The UHREC will request annual status reports for all protocols, one year after the last approval
date. Modification requests can be submitted as required, by submitting to the UHREC a
memo describing any changes, and an updated copy of this document.

I hereby declare that this Summary Protocol Form accurately describes the research
project or scholarly activity that I plan to conduct. Should I wish to add elements to my
research program or make changes, I will edit this document accordingly and submit it to
the University Human Research Ethics Committee for Approval.

ALL activity conducted in relation to this project will be in compliance with:

         The Tri Council Policy Statement: Ethical Conduct for Research Involving Human

         The Concordia University Code of Ethics: Guidelines for Ethical Actions

  Signature of Principal Investigator:________________________________________

  Date:         ____________________________
  Note that SPF’s with electronic signatures will be accepted via e-mail


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